Topic: Interpreting Your Report

Forum: Not Diagnosed But Worried — For those who are experiencing symptoms or received concerning test results, but haven't been diagnosed with breast cancer.

Posted on: Aug 25, 2017 11:30AM - edited Mar 22, 2018 09:57AM by djmammo

Posted on: Aug 25, 2017 11:30AM - edited Mar 22, 2018 09:57AM by djmammo

djmammo wrote:

Mammogram and ultrasound reports contain (should contain) a fairly specific vocabulary as recommended by the Birads Lexicon. They have very specific meanings so if used correctly other docs can picture in their mind what the abnormality looks like without seeing the actual images.

I have divided the more common terms into 2 groups Favorable and Less Favorable, favorable meaning it leans toward the benign side, and less favorable if leaning toward the malignant side (as no finding is 100%). This in combination with the Birads score should give you a good idea about what the rad is considering if in fact they did not speak directly to you about your results. Below that is a link for a downloadable guide which is more complete.

Favorable: Oval; parallel; circumscribed; anechoic; hyperechoic; isoechoic; posterior enhancement or good through-transmission; avascular; macrocalcifications include pop corn, large rod like, rim, milk-of-calcium.

Less Favorable: Irregular; non-parallel (can also be written as "taller-than-wide"); not-circumscribed margins includes indistinct, angular, microlobulated, and spiculated; hypoechoic; posterior shadowing; architectural distortion; internal vascularity; microcalcifications including amorphous, coarse heterogeneous, branching, fine pleomorphic.

Downloadable Quick Reference Guide PDF which also includes MRI terminology

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Nov 30, 2017 03:32AM - edited Nov 30, 2017 04:19AM by Cutie1112

1st u/s scan:
Ill-defined hypoechoic lesion at 12 o'clock 2cm fm nipple measuring 0.6x 1.4x 1.3cm.
Another lesion more well-defined at 10 o'clock 4cm from nipple measuring 0.9x1.5x 1.3cm, wide receiver than taller, with posteriors shadowing and no intralesional color dropped within.
A biopsy was done, at 3 attempts with 2 good samples, results: no maglinancy evidence found.
2nd scan after 3months:
well defined hypoechoic lesion seen at
- 12 o'clock 1cm from nipple: 0.6x1.4x 1.5 cm
-10 o'clock 4cm from nipple: 0.8 x 1.4x 1.5cm
No posterior shadowing or enhancement. no intralesional color dropped within.no calcification.
A few subcentimeters axillary lymph nodes with preserved fatty hilum bilaterally.
Question:
1. should I believe the biopsy results it is benign and should not worry about it?
2. My doctor asked me to removed the lump. Is it necessary if biopsy said they are benign?
3. What is axillary lymph nodes with preserved fatty hilum. Should I be worry it?

Need advice please


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Nov 30, 2017 03:10PM - edited Nov 30, 2017 03:13PM by djmammo

Cutie

1. should I believe the biopsy results it is benign and should not worry about it?

If the radiologist states correct site was biopsied and the pathologist indicates that the samples were adequate for analysis, then yes.

When the rad who does the biopsy gets the path report they generate a report indicating whether or not they agree with the path findings and issue a report with a recommendation. Ask for that report.

2. My doctor asked me to removed the lump. Is it necessary if biopsy said they are benign?

Did they tell you it should be removed or did they ask you if you wanted it removed?


3. What is axillary lymph nodes with preserved fatty hilum. Should I be worry it?

That is a description of a normal lymph node. We don't worry about the normal ones.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Dec 5, 2017 06:05PM Eljay62 wrote:

I have seen the breast surgeon on Monday. She seemd a little concerned in regards to the complex fibroadenoma & wants to keep an eye on it with 6 monthly ultrasounds. She thinks microcalcifications are either early DCIU or fat necrosis from breast reduction. I came away doubting the 2nd possibility as my reduction was 14 years ago plus it has never been seen on mammo before May this year. I am booked for stereotactic biopsy next Wednesday & should have pathology results back before Christmas.

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Dec 10, 2017 01:31PM - edited Dec 10, 2017 01:53PM by luvpinkcmc

djmammo,

Hoping you can help with my report, biopsy is scheduled on the 18th and the unknown has made me a nervous wreck, I am 42 yrs old.


Mammogram report: (3D/2D with cad study)

Clinical: Palpable lumps inferior bilateral breast by history

Both breasts are extremely dense, which lowers the sensitivity of mammography.

Examination indicates a biopsy marker in the right breast.

There is a 7mm round mass with an obscured margin in the right breast at 11 o'clock anterior depth. This correlates to the area of reported pain and with ultrasound findings. No other significant masses, calcifications, or other findings are seen in either breast.

Suspicious of Malignancy

The 7 mm round mass in the right breast is at a low suspicion for malignancy. An ultrasound guided biopsy is recommended. There is no abnormality seen in either breast to correspond with the area of clinical concern in the lower aspect, however, clinical followup is recommended.

Letter sent: Abnormal/Biopsy BIRAD 4-5


Ultrasound report: (US breast bilateral limited)

Clinical: Bilateral palpable lumps inferiorly. Pain right upper outer.

Color flow and real-time ultrasound of the right breast and real-time ultrasound of the left breast were performed. Gray scale images of the real-time examination were reviewed.

There is a 0.6 cm x 0.5 cm oval mass with an angular margin in the right breast at 11 o'clock anterior depth 1 cm from the nipple. This oval mass is hypoechoic with internal echos. This correlates to the reported pain and with mammography findings. Color flow imaging demonstrates that there is no vascularity present.

Impression: Suspicious of Malignancy-Follow Up Recommended

The 0.6 cm x 0.5 cm oval mass in the right breast is at a low suspicion for malignancy. An ultrasound guided biopsy is recommended. There is no abnormality seen in either breast to correspond with the area of clinical concern in the lower aspect, however, clinical followup is recommended.

Letter sent: Abnormal/Biopsy BIRAD 4-5


The above information is verbatim from my report, sorry it is so long. Part of what confuses me is the Abnormal/Biopsy BIRAD of 4-5 but then there's a sentence that says there is no abnormality seen in either breast to correspond with the area of clinical concern in the lower aspect........ Should I be concerned?

Thanks in advance for any insight!

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Dec 11, 2017 11:37AM djmammo wrote:

Luvpink

If verbatim, the report is a little confusing, but perhaps what they are concerned about is something you are not currently feeling ? Unclear at minimum.

The finding they want to biopsy is very small and they feel it is low suspicion which is good but they do not seem familiar with proper Birads assignment. There is no "Birads 4-5", there is 4a, 4b, 4c to convey their level of suspicion or 5 if they are convinced it is cancer from the imaging. Either one gets you a biopsy.

Did you have a prior mammogram? Did they compare new and old studies?

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Dec 11, 2017 02:58PM luvpinkcmc wrote:

Thanks for responding djmammo! At the bottom it says Birads 4a, I missed that, so that corresponds with the low suspicion, right? But it does still say Birad 4-5 under the heading "Letter sent", which has me freaked out because my mom had a birad 5. I don't understand why he would put that.

I did have previous mammograms that they compared, one in May 2013 and March 2014. In 2013 the mammogram showed an area of asymmetric density in the right breast, I was called back for more imaging and deemed all was ok but they wanted to see me in 6 months. I went back in March of 2014 and nothing had changed and I received a benign report that said come back in a year. I waited almost 4 years to get another mammogram :( not very smart on my part. I have a sister and mother with breast cancer.

I initially thought this sentence "There is no abnormality seen in either breast to correspond with the area of clinical concern in the lower aspect, however, clinical follow up is recommended" was referring to my doctors concern of "palpable lumps inferior bilateral breasts" Could that be what its referring to? I don't feel any lumps and when she examined me she didn't say she felt anything either. All I've had is a burning from within pain on the right side.

I agree the report is confusing, it doesn't seem like it offers enough of a description but then again I could be wrong about that also.

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Jan 8, 2018 11:28PM Monique72 wrote:

I can’t understand why I was given only a Birads 4 (with no a, b, or c) and not a 5 with this description:

“...palpable...approximately 12 o’clock, 3cm from nipple....irregular, non-parallel solid mass...2 x 1.1 x 1.1cm. The most suspicious component, with more posterior acoustic shadowing and spiculated margins, is in the superior aspect of this and measures 1.2 x 1.0 x 0.7cm”

This does not sound like a 4 to me, more likely a 5, because it fits EVERY description for cancer that I’ve read.

I had the biopsy today. My mother died of breast cancer at 65 and my sister had it at age 35. She had IDC with node involvement. She is 50 now & all clear. I am 45. Both sister and mother dealt with poor screening & inadequate care due to being poor and living in a poor area of the country.

I had two mammograms this past year some 9 months apart, both showed no abnormality. Only the ultrasound and palpation show that there is a problem.

I’m irritated that the hospital sends a letter with these necessary details to my primary care doc, but treats me like I’m an idiot by telling me next to nothing.

My health insurance sucks, I’ve had a month’s worth of runaround before I could have the biopsy authorization. I’m beyond disgusted. The billing department called me before anyone involved in my care has. In fact, no one involved in my care has contacted me at all. I feel like a number, and a presumed poor dumb number at that, which truly sucks

Diagnosed with PASH tumor 1/16/2018
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Jan 9, 2018 09:32AM djmammo wrote:

Monique72 et al

As long as it is biopsied the Birads # 4 vs. 5 really doesn't matter. These number are tracked by the MQSA and used to evaluate the radiologist reading the studies. Its a way of keeping score and insuring quality readings. In the beginning they really weren't intended for patients' review.

As many radiologists were using their own nomenclature for findings and results back in the day, it was felt there should be one common denominator that any referring doctor could understand no matter who was reading it and it was decided that numbers should be used. Later, strict adherence to a particular vocabulary was introduced and together with the numbers make up the Breast Imaging Reporting and Data System. A lay letter was then proposed and its distribution to patients made law as a sort of bottom line summary of the patient's mammogram report. Back before the internet, patients were not familiar with the wording of x-ray reports and the lay letter was deemed the solution. Now that patients have access to their reports on line, and Google, there is a tremendous interest in the report itself. It's turned out to be a double edged sword.

Let us know what the path report says when its available.


Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Jan 9, 2018 09:40AM djmammo wrote:

I'm sure I have posted this elsewhere but here it is again the BIRADS 5th Edition quick reference card you can print out and glue to some cardboard (that's what I did). It lists the acceptable breast imaging terminology for all modalities and their definitions, the meaning of the Birads #'s for both density and diagnosis. If your breast imaging center uses these terms exclusively, thats a good sign.

Click here to download

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Jan 9, 2018 12:17PM momto3sons wrote:

Hi djmammo! Can you help shed some light on my report? This is the main part of the summary from the radiologist (there was more in there about several cysts, but those are noted as most likely benign):

IMPRESSION: SUSPICIOUS OF MALIGNANCY, ULTRASOUND

PROBABLY BENIGN

The architectural distortion in the right breast at

11-12 o'clock posterior depth is suspicious of

malignancy. A surgical consult is recommended. There

is no US correlate and no h/o prior biopsy. This has a

suspicious appearance on mlo tomo views. Surgical

consult regarding physical exam findings recommended.

Needle loc would be preferable to stereotactic biopsy

and breast MR would be recommended for evaluation of

this area as well

letter sent: BIRADS 4/5 Exam

MAMMOGRAPHY BI-RADS: 4 Ultrasound BI-RADS: 3

Breast Tissue Density: C - The breasts are

heterogeneously dense, which may obscure small masses


I did have an appointment with a surgeon, but she couldn't feel anything in the area where they noted the architectural distortion. She's ordered an MRI, but we have to see if insurance will cover it.

Carolyn, mom to 3 sons - ADH, intraductal papillomas 3/1/18 Surgery 2/22/2018 Lumpectomy; Lumpectomy (Right)

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